Making the Medicare Prescription Drug Program Work For Boomers and Their Parents

No one knows better than people with diabetes how expensive prescription drugs are. A recent DH article reported that the annual cost for drugs to treat type 2 diabetes nearly doubled between 2001 and 2007, skyrocketing from $6.7 billion to $12.5 billion six years later.

That’s why a press release from gerontologist and eldercare expert Esther Koch caught our eye. Koch provides personal and corporate advisory services and educational products to assist Boomers with issues associated with caring for an aging parent and their own aging. More information and links follow this article.

Koch says in the press release, “When it comes to prescription drug coverage, seniors fall into four groups:

Seniors with employee or retiree drug coverage

People in Medicare Advantage Plans with drug coverage

People in low-income subsidy programs

Seniors in stand-alone Medicare Prescription Drug Plans or who have no prescription drug coverage

It’s that last group that needs to act, and Koch offers this essential guidance for them.

Seniors must review their drug plans every year.

Why? Because even if their medications haven’t changed, it’s almost certain that their plan’s formulary of drugs covered and pricing have. “Medicare contracts with a variety of insurance companies to cover drug costs. What few seniors or caregivers know is that these insurance companies submit new plans to Medicare each year,” says Koch. Last year’s plan is not this year’s plan, and that means that it’s unlikely that the best plan for you last year is still the best plan for you this year. In fact, Koch says, she has yet to have a client whose optimum plan choice remained the same each year.

A higher premium doesn’t mean more or better coverage.

It seems logical that a drug plan with a higher premium is going to give you more benefits, but when it comes to Medicare Prescription Drug Plans, this simply isn’t true. “What you need to focus on is total estimated annual cost,” notes Koch. This takes into consideration all the variables, including the plan’s formulary of drugs; individual drug classifications and pricing; monthly premiums; deductible amount; whether “doughnut hole” coverage is provided; and when catastrophic coverage is triggered. She likens the process of choosing a Medicare Prescription Drug Plan to comparison shopping for holiday gifts. “If you can buy the same gifts at Store A for 50 percent cheaper than at Store B next door, you’d buy them at Store A. The same principle applies here. You need to compare the total estimated annual cost of your parents’ specific drugs by plan and then choose from among the least expensive plans,” she says.

Web-savvy Boomers need to be involved.

If choosing the right plan sounds like it requires sifting through a lot of information, it does. Luckily, the government offers a powerful online tool that makes this process easy to manage. “Web-savvy Boomers can help their parents compare stand-alone drug plan choices by using the Medicare Prescription Drug Care Plan Finder at www.medicare.gov,” says Koch.

By entering their parents’ ZIP code, drug names, dosage information, and 30-day supply amounts, Boomers can obtain a prioritized list of prescription drug plan options sorted from the least expensive to the most expensive, based on total estimated annual cost. The five least expensive plans will show up initially. You can display all plans, do a side-by-side comparison of three plans, and drill down to obtain specific information on how to lower drug costs. The drug list can even be saved for later reference.

An added benefit is that the children of senior parents become informed of all of the medications their parents are taking and more knowledgeable about their parents’ health conditions and insurance coverage. “This is a wonderful opportunity for Boomers to be there for their parents and to take an active role in their healthcare. They need you!” says Koch.

Koch also points out that some recent announcements indicate that seniors may have inadequate information at their disposal. In September, the U.S. Senate Special Committee on Aging revealed the results of a three-and-a-half-year study on the effectiveness of the 1-800-MEDICARE call center-the resource seniors are most likely to use. They found that the call center frequently dispensed inaccurate information and inappropriate referrals and had unacceptably long wait times.

In the same month, the Centers for Medicare and Medicaid Services issued stringent regulations regarding the marketing activities that private insurance companies can engage in during the Annual Election Period. While this should curb questionable practices, it also means that seniors may have less information available to them unless they request it.

For Koch, this reinforces the need for adult children to be involved their parents’ health planning. “Adult children need to take the lead in helping manage their parents’ healthcare, and the Annual Election Period is the perfect time to begin,” she says.

Esther Koch is a gerontologist and eldercare advisor based in San Mateo, California. She is the founder and CEO of Encore Management, which provides personal and corporate advisory services and educational products to assist Boomers with the issues associated with caring for an aging parent and their own aging. Koch is a Medicare Aging Network Partner with the Administration on Aging and the Centers for Medicare and Medicaid for the Medicare Prescription Drug Program. In 2005, she was honored to be selected as a delegate to the White House Conference on Aging. Koch received her graduate degree in gerontology from USC and is a member of the National Association of Professional Geriatric Care Managers, the Business Forum on Aging of the American Society on Aging, and AARP. Her website is www.ENCOREmgmt.com

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